Child Behavior

What is Clean Intermittent Catheterization?

If your child cannot empty his or her bladder completely, or has a problem with urine leakage, your child may need to start a catheterization program. These problems are commonly seen in children with spina bifida, spinal cord injuries, or some urinary tract defects.

Clean intermittent catheterization (CIC) is a technique used to remove urine from the bladder. This is done by placing a thin, flexible tube (catheter) through the urethra into the bladder to drain the urine.

This brochure will help you understand the basics of CIC. It includes instructions for girls and boys. It does not take the place of one-to-one teaching. Contact your pediatrician, doctor, or nurse practitioner if you have any questions.

Why is CIC important?

Urine is the waste product that is produced by the kidneys. The bladder is the container in the body that holds the urine until it is emptied. The human body needs to empty its bladder of urine several times a day. The bladder can be drained by urinating or by using a catheter.

If your child needs CIC, your doctor will tell you how often your child's bladder should be emptied. It can be as often as every 2 to 4 hours depending on your child's condition.

CIC is especially important for the following reasons:

Reduces accidents. It lets your child empty his bladder so he has fewer accidents. Older children may no longer need to wear diapers. It helps stop the odor and skin problems that come from being wet with urine.

Reduces the risk of urinary tract infections. Emptying the bladder regularly reduces the risk of urinary tract infections caused by bacteria that stay in the bladder too long.

Reduces the risk of reflux. Reflux is a condition where urine from the bladder goes back up to the kidneys. This can cause serious kidney damage.

What supplies are needed?

It is best to have all of your supplies organized and ready when you need them. Keep the following items in a clean, dry container such as a plastic shoe box or cosmetic case.

Catheters. Your doctor will give you a prescription for the appropriate catheter size for your child.

Disposable wipes or a washcloth. Your child's genitalia will need to be cleaned before CIC.

Lubricant. Use only a water-soluble lubricant. You can buy the lubricant at pharmacies or drug stores. Do not use oil-based lubricants such as petroleum jelly because they do not dissolve in water.

Container. You may need a container to drain the urine into if you are not doing the catheterizations on the toilet, or if you need to keep a record of how much your child drains.

Syringe. You will need a syringe for cleaning the catheter.

CIC for girls

First wash your hands with soap and water, then dry them. You also can use a waterless cleaner, such as an antibacterial cleanser that does not require water.

Next have your box of supplies within easy reach.

Place your daughter on her back or position her on the toilet or in her wheelchair. You should practice CIC in the position you will be using most often. If she is on the toilet, separate her legs widely enough to be able to clearly see her urethra. If she is doing her catheterizations herself, she will practice identifying her urethra by touch. When your daughter is learning to catheterize herself, she can use a mirror to see where her urethra is located.

Clean your daughter's genitalia with a washcloth or disposable wipe.

Separate the labia and wipe thoroughly from front to back.

Place a generous amount of the water-soluble lubricant on the end of the catheter with the holes.

Place the other end of the catheter into a container or let it drain into the toilet.

Find your daughter's urethra (see picture below). Gently insert the lubricated end of the catheter into the urethra about 2 to 3 inches. It may become slightly more difficult to insert just prior to entering the bladder. That is because a muscle called the sphincter sits at the opening of the bladder and is naturally tightly contracted. The sphincter will relax as you continue to gently insert the catheter until you reach the bladder and see urine flow.

Once the catheter is in the bladder, hold it there until the urine flow stops. Then move the catheter slightly, or insert it a little more, to see if the flow continues. Gently press on your daughter's lower abdomen with your hand or ask your daughter to lean forward to be certain there is no more urine in the bladder.

Slowly remove the catheter, holding your finger at the tip or pinching the catheter end before removing the final portion. Pull catheter out in a downward movement to prevent backflow of urine.

Wash your hands. Clean and store your catheter as directed.

CIC for boys

First wash your hands with soap and water, then dry them. You also can use a waterless cleaner, such as an antibacterial cleanser that does not require water.

Next have your box of supplies within easy reach.

Place your son on his back or, if it is easier for both of you, have him sit on the toilet or in his wheelchair. If he is doing his own catheterization, he may stand or sit on the toilet or in his wheelchair.

Clean the tip of his penis with a washcloth or disposable wipes in a circular motion starting at the center and working outward. If your son is uncircumcised, pull back the foreskin so that the tip of his penis is visible before cleansing.

Place a generous amount of the water-soluble lubricant on the end of the catheter with the holes.

Place the other end of the catheter into a container or let it drain into the toilet.

Hold your son's penis upright. Gently insert the lubricated end of the catheter into the urethra (see picture below) about 4 to 6 inches until urine begins to flow. You may need to lower the penis as you continue to insert the catheter. It may become more difficult to advance the catheter as you get closer to the bladder. Do not worry, this is normal. Continue to gently insert the catheter with steady pressure until you feel the catheter slip into the bladder. Once urine flow begins, insert the catheter about an inch farther to allow the urine to flow better.

Hold the catheter in place until the urine flow stops. You may gently press on your son's lower abdomen or ask him to squeeze his abdominal muscles or lean forward to be sure the bladder is empty.

Remove the catheter once the urine flow stops completely. Hold your finger over the end of the catheter while removing it. This will prevent any urine in the tube from dripping out.

If your son is uncircumcised, gently replace the foreskin over the end of his penis by pushing it forward.

Wash your hands. Clean and store your catheter as directed.

Cleaning your supplies

It is very important that you keep your child's CIC supplies clean. Make sure you wash your hands often and well whenever you perform CIC. If you are using disposable catheters, throw the catheters away after each use.

If you have reusable catheters (metal or latex-free), then you should wash them with soap and water after each use. You can use a syringe to squirt soapy water and plain water through the catheters. Rinse them completely and allow them to dry. After they are dry, store them in a plastic bag, traveling toothbrush holder, or any other clean container.

Throw catheters away as soon as they become brittle or lose their flexibility, or the holes become rough.

When to call your doctor

Call your doctor if your child is having any of the following problems or symptoms of a urinary tract infection:

Fever

Abdominal or back pain

Pain or burning during CIC

Less urine than usual from CIC

Frequent need to urinate or catheterize

Leaking of urine between catheterizations (more than usual)

Cloudy or hazy urine with a strong odor

Bloody urine

Remember

It may take a while to get used to doing CIC, but keep in mind that as you and your child become more used to this process, it will become easier. Talk with your child about CIC to explain exactly what you are doing. If your child is not doing CIC on his own, explain that when he is old enough he should be able to do CIC without your help. Encourage your child to be independent. And remember, it is natural for you or your child to have questions. Feel free to talk with your doctor about any questions or problems that you or your child are having with CIC. Eventually CIC can help make things easier and better for you and your child.